Patients for Hire, Doctors for Sale

Published: May 22, 1999

People go to doctors because they assume the doctor will tell them what they need to do to stay healthy or get well. But in articles published in The Times on Sunday and Monday, the reporters Kurt Eichenwald and Gina Kolata have opened the door on a practice of medicine that few of us knew existed -- a warped world in which patients have become commodities, lured into research projects for the profit of their doctors.

In pushing to create a supermarket of new pills, the pharmaceutical industry has created a frantic competition for patients on whom new drugs must be tested before they can be approved. A bounty system has evolved in which doctors are paid by drug companies to enroll research subjects with certain kinds of problems: $1,200 from Bayer for a patient with vaginitis; $2,955 from Merck for one with hypertension; $4,410 from SmithKline Beecham for a willing diabetic. The devil's bargain is that the doctor knows that enrolling the patient is worth money, but the patient does not. It is a recruiting system with the potential to corrupt either the drug companies, because they are forced to outbid each other for patients, or the doctors, because they are tempted to enroll patients who may not be medically appropriate.

The articles reveal a whole research universe slipping out of control. A review by The Times of more than 300 recent drug studies, and more than 200,000 government research request files, found hundreds of thousands of patients involved and indications that some doctors make $500,000 to $1 million a year in recruitment bounties. One Southern California doctor now in prison forged his patients' medical records and test results on a massive scale to boost his income.

In the past, most clinical trials of drugs were conducted by doctors at medical research institutions. But that system proved too slow at recruiting patients, so the drug companies and their contractors turned to doctors in private practice, tripling their number since 1990. Meanwhile, the monitoring systems to protect patient welfare, already under fire for past performance, have shown no interest in the ethical conflict of doctors being paid to recruit their own patients.

Dr. Nancy Dickey, president of the American Medical Association, says that the bounty system is unethical by A.M.A. standards and that the organization will work with Federal regulators to try to end the practice. They need to act expeditiously. The patient search has now begun to tap the poor populations of South America, threatening to corrupt the practice of medicine even more widely.